小结
定义
病史和体格检查
关键诊断因素
- 存在的主要危险因素
- 高血压发病年龄＞55 岁
- 急进性、恶性或难治性高血压病史
- 不明原因的肾功能障碍病史
- 多支冠状动脉病变史
- 其他外周血管疾病史
- 腹部血管杂音
- 突然或不明原因的复发性肺水肿
- 高血压发病年龄＜30 岁
其他诊断因素
- 无高血压家族史
- 其他杂音
- ACE 抑制剂或血管紧张素 II 受体拮抗剂给药后发生的急性肾损伤病史
- 不明原因的充血性心力衰竭病史
- 难治性心绞痛
- 低钾血症史
危险因素
- 血脂异常
- 吸烟
- 糖尿病
- 女性
诊断性检查
首要检查
- 血清肌酐
- 血钾
- 尿液分析和沉积物评估
- 醛固酮与肾素比值
需考虑的检查
- 双功超声
- 钆增强磁共振血管造影（MR Angiography, MRA）
- CT 血管造影术
- 传统血管造影术
- 二氧化碳（CO2）血管造影
- 非增强磁共振血管造影
- 卡托普利放射核素肾扫描
治疗流程
动脉粥样硬化性 RAS
肌纤维发育不良
撰稿人
作者
Mauricio Leitao, MD, MBA
Clinical Research Coordinator
University of Massachusetts Chan Medical School
UMass Memorial Medical Center
Worcester
MA
利益声明
ML declares that he has no competing interests.
Alvaro Alonso, MD, MSCR, FSVM
Associate Professor of Medicine
University of Massachusetts Chan Medical School
UMass Memorial Medical Center
Worcester
MA
利益声明
AA declares that he has no competing interests.
鸣谢
Dr Alvaro Alonso and Dr Mauricio Leitao would like to gratefully acknowledge Dr Rohit Malhotra, Dr Manmeet Singh and Dr Scott J. Gilbert, previous contributors to this topic. RM, MS and SJG declare that they have no competing interests.
同行评议者
Robert Tompkins, MD
Associate Professor
Department of Family Medicine
University of Texas Health Science Center
Tyler
TX
利益声明
RT declares that he has no competing interests.
Irfan Moinuddin, MD
Assistant Professor
Chicago Medical School
Rosalind Franklin University
Lombard
IL
利益声明
IM declares that he has no competing interests.
John Webster, MD
Professor
Aberdeen Royal Infirmary
Foresterhill
Scotland
利益声明
JW declares that he has no competing interests.
Neil A. Kurtzman, MD
Grover E. Murray Professor
University Distinguished Professor
Texas Tech University Medical Center
Lubbock
TX
利益声明
NAK declares that he has no competing interests.
鉴别诊断
- 原发性高血压
- 急性肾损伤
- 肾动脉夹层
更多 鉴别诊断指南
- ACR 适宜标准：肾血管性高血压
- 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA 成人高血压预防、检测、评估和管理指南：美国心脏病学会/美国心脏协会临床实践工作组的报告
更多 指南患者教育信息
高血压：什么是高血压？
高血压：如何有效治疗？
更多 患者教育信息
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